T. Warticovschi1,2, A. Abdelzaher1,2, C. Andrade3, S. Sun1,2, A. Yildiz1,2, C. Zivanov1,2, U. Panni1,2, R.C. Fields1,2 1Washington University, Department Of Surgery, Divison Of Surgical Oncology, St. Louis, MO, USA 2Siteman Cancer Center, St. Louis, MO, USA 3Washington University, Department Of Surgery, Division Of Public Health Sciences, St. Louis, MO, USA
Introduction:
Overutilization of sentinel lymph node biopsy (SLNB) in early-stage melanoma can lead to unnecessary morbidity. The Melanoma Institute of Australia (MIA) Melanoma Sentinel Node Metastasis Risk Assessment Tool aims to identify patients who would most benefit from SLNB. Shared decision-making (SDM) is an evidence-based, patient-centered practice that could leverage the MIA risk prediction tool to help patients understand the risks and benefits associated with SLNB. This study aims to characterize clinician and patient preferences regarding the MIA Risk Assessment Tool and its use in SDM for patients considering SLNB.
Methods:
National melanoma experts from multiple academic centers and adult patients diagnosed with early-stage melanoma who underwent surgical management within the past 5 years participated in semi-structured interviews. The interview guides were modeled using the Consolidated Framework for Implementation Research (CFIR). Interviews covered participants' perceptions of the evidence base for SDM, relative advantages of using SDM in this context, individual and institutional factors influencing SLNB decision-making, and factors influencing the use of the MIA tool. All interviews were recorded, transcribed, and analyzed thematically using NVivo14 to identify key themes.
Results:
To date, semi-structured interviews have been conducted with 6 clinicians and 6 patients. Preliminary analyses revealed several key themes: Overall, clinicians and patients understood and valued SDM, though the desired levels of patient involvement varied. Factors influencing SLNB decision-making included cancer stage, risk factors, patient age, overall health, patient preferences, and guideline recommendations. Both groups highlighted the strengths of the MIA tool to support SDM with participants noting improved risk communication, helpful visual risk representation, increased clinician confidence, and potential for reducing unnecessary or unwanted procedures. However, these were balanced by concerns about time constraints, patient comprehension, tool accuracy, optimal workflow integration, and limited awareness of the tool among clinicians, particularly at non-academic centers. Suggestions for improvement encompass simplified language, additional procedural information, further personalization, and post-consultation access to information.
Conclusion:
The MIA Sentinel Node Metastasis Risk Assessment Tool shows promise in enhancing SDM for SLNB in early-stage melanoma. While it has the potential to improve risk communication and reduce unnecessary or unwanted procedures, the tool presents identified barriers that could hinder its successful implementation. Addressing these barriers and improving aspects of the MIA tool could significantly improve the quality of care and personalization for early-stage melanoma patients.